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Posts tagged ‘EAU’

One of the ongoing debates in prostate cancer and urology is the value of routine screening of all men in a certain age group.  There was a difference of opinion amongst the experts at the recent European Association of Urology (EAU) Congress in Vienna.

Prof Schroder from Rotterdam outlines potential benefit and harm from prostate cancer screeningProfessor Schröder from Rotterdam summarized what he tells a man who is considering prostate cancer screening:

Benefit: If your prostate cancer is detected by screening, your chance of dying within 10 years is reduced by at least 20%

Harm: Screening may detect cancer which would never harm you and you may undergo treatment for no good reason.

Research published in the British Medical Journal (BMJ) on March 31, 2011 adds weight to the body of data that suggests general prostate cancer screening is of little or no benefit.

In an open access BMJ paper, Gabriel Sandblom and colleagues showed that prostate cancer screening did not reduce death rate in a randomly selected population of men between 50-69 who were followed for 20 years.

The study methodology is worth noting.

Take a city in Sweden and randomly select every sixth man aged between 50-69 and screen them for prostate cancer every 3 years. That’s what happened in 1987 in the City of Norrköping in Sweden.

1497 men received four screenings from 1987 to 1996, with the first two being digital rectal examinations (DRE), and the final two screenings combining this with measurement of prostate specific antigen (PSA).

The conclusion from the results published in the BMJ is that :

“After 20 years of follow-up the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the control group.”

There is an ongoing debate on the value of population based screening for prostate cancer, a disease that may affect 1 in 6 men.  Like mammography, the benefits of prostate specific antigen (PSA) screening are hotly debated given the potential for overdiagnosis and overtreatment.

The results from the Norrköping study clearly show that where there is no assessment of risk factors or focus of screening on those who might be at risk, there is no significant difference in mortality between those screened and those who are not screened.  The study results:

“did not show a significantly longer prostate cancer survival (P=0.065) or overall survival (P=0.14) for men with prostate cancer diagnosed in the screening groups.”

This study of a large group of men over a long-period of time suggests that the risks of screening the general population may not outweigh the potential benefits.

The authors note that in the ERPSC prostate cancer screening trial published in the New England Journal of Medicine in 2009 it was estimated that “to prevent one death from cancer, 1410 would need to be screened and 48 treated.”

While there are advantages if you are the lucky man whose death is prevented, the 47 who have to be treated to “save” you are not so lucky since they undergo treatment risks such as erectile dysfunction, urinary incontinence and bowel problems, not to mention the discomfort associated with prostate cancer biopsy and psychological effects of receiving a false positive result.

This study of 1497 men in a Swedish city over 20 years does not definitively answer the question of whether screening should be done or not.  As we have seen in the debate around breast cancer mammograms, emotion can drive health policy decisions as much as scientific data.

However, it does suggest that indiscriminate prostate screening may not be the way to go until more sensitive biomarkers of the disease other than PSA are developed or as the authors in their paper suggest screening is better able to discriminate “indolent tumours from high risk tumours.”

ResearchBlogging.orgSandblom, G., Varenhorst, E., Rosell, J., Lofman, O., & Carlsson, P. (2011). Randomised prostate cancer screening trial: 20 year follow-up BMJ, 342 (mar31 1) DOI: 10.1136/bmj.d1539

Today at the European Association of Urology (EAU) annual meeting in Vienna, the big news was that 2010 was a “Grand Cru” year for new treatments for advanced prostate cancer.  Not only that, but sanofi-aventis announced that they had received European marketing approval for cabazitaxel (Jevtana®) in metastatic hormone resistance prostate cancer mHRPC.

The fact that there are now several new treatments available (or expected to be available in the not too distant future) is good news for patients and physicians.

What is interesting about prostate cancer is that it in terms of incidence it is comparable to breast cancer, yet seems to end up with far fewer resources and publicity.  Prostate cancer is to men, what breast cancer is to women.

The EAU 2011 Congress website has a variety of podcasts and webcasts of presentations, and I encourage anyone interested in the latest developments to check out the wealth of information they offer.  In particular, the presentation by Professor Johann De Bono from the Royal Marsden in the high risk prostate cancer plenary session today was one of my highlights of the meeting.

The take home message I obtained from EAU in Vienna is the excitement of new treatment options for castration resistant prostate cancer (CRPC) such as cabazitaxel, sipuleucel-T and abiraterone.  The challenge may well be to work out how best to use these new therapies, ie in what sequence and what potential combinations may evolve in the future.

However, as Professor Bertrand Tombal from Louvain in Belgium declared, 2010 was a Grand Cru for new prostate cancer treatments.  That is good news indeed.

 

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